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At least 487 records · Page 27Linked to original sources
PubMed2002

The cost-effectiveness of telehealth in metropolitan hospitals.

We established a telehealth link between two inner-city health services about 10 km apart. The video-link between the sites was based on IP videoconferencing; ISDN connections were maintained as a form of system redundancy and to connect to sites beyond the local area network. The cost of a conventional consultation, in which the patient travelled to an outpatient appointment, was A$170. Because existing equipment and telecommunications could be used, the cost of a telehealth consultation was only A$74. During the study approximately 15 teleconsultations were completed and a number of patient transfers were cancelled because they were deemed clinically unnecessary. The preliminary results suggest that the cost-savings from telehealth can be substantial. In addition there were major benefits to continuity of patient care and clinical communication within the organization.

Journal Article↗
PubMed2002

International distance education and the transition from ISDN to high-bandwidth Internet connectivity.

The Thailand Hawaii Assessment of Interactive Healthcare Initiative (THAI-HI) is an international distance-education project between two teaching hospitals in Honolulu and Bangkok that uses videoconferencing over three ISDN lines. A 'morning report' format is used to discuss clinical cases primarily covering infectious disease and critical-care topics. An audience response system is used at both sites to add interactivity. From July 2001 to May 2002, 816 health-care providers attended 20 clinical conferences. Audiences rated the conferences as highly relevant and as having high training value. Since the ISDN connection is expensive, we plan to convert the telecommunications to a high-bandwidth Internet connection. The Honolulu site will use a 45 Mbit/s commercial connection to the Hawaii Intranetwork Consortium, which links to the Abilene Network on the US mainland. The Bangkok hospital will use a 155 Mbit/s wireless optical connection to UNINET Thailand, which has a 45 Mbit/s circuit to Abilene.

Journal Article↗
PubMed2002

Logistical aspects of large telemedicine networks. 1: Site directories.

We carried out a survey of the site coordinators in a mature telemedicine network of about 200 sites. The site directory contained information about 221 videoconference facilities. There were 191 site coordinators in all (i.e. some coordinators were responsible for more than one site). Of the 221 sites, we were able to contact 87 on first attempt and 155 by the fourth attempt. Thus there were 66 sites (30%) which were not contactable. We asked each site coordinator to describe any videoconference activity that had taken place over the previous five working days. Of the contacted 155 sites, 78 reported some videoconference activity during the period in question. The total reported videoconference activity was 12,800 min during the one-week monitoring period, that is, an estimated 924 h per month. The most common categories of work were education or training (511 h) and management or administration (225 h), which between them accounted for 80% of all reported videoconference activity. Fifty of the 155 sites (32%) reported that the equipment was not located in an area suitable for patient consultations. In addition, 20 sites (13%) volunteered that their videoconferencing facilities were not in working order at the time of the survey. We did not ask this question in the survey, so that this result represents a lower bound for the true number of inoperable systems.

Journal Article↗
PubMed2002

Logistical aspects of large telemedicine networks. 2: Measurement of network activity.

We carried out a retrospective review of the videoconference activity records in a university-run hospital telemedicine studio. Usage records describing videoconferencing activity in the telemedicine studio were compared with the billing records provided by the telecommunications company. During a seven-month period there were 211 entries in the studio log: 108 calls made from the studio and 103 calls made from a far-end location. We found that 103 calls from a total of 195 calls reported by the telecommunications company were recorded in the usage log. The remaining 92 calls were not recorded, probably for one of several reasons, including: failed calls - a large number of unrecorded calls (57%) lasted for less than 2 min (median 1.6 min); origin of videoconference calls - calls may have been recorded incorrectly in the usage diary (i.e. as being initiated from the far end, when actually initiated from the studio); and human error. Our study showed that manual recording of videoconference activity may not accurately reflect the actual activity taking place. Those responsible for recording and analysing videoconference activity, particularly in large telemedicine networks, should do so with care.

Journal Article↗
PubMed2003

A comparison between three electronic media and in-person learning for continuing education in physical rehabilitation.

We produced continuing education material in physical rehabilitation using a variety of electronic media. We compared four methods of delivering the learning modules: in person with a computer projector, desktop videoconferencing, Web pages and CD-ROM. Health-care workers at eight community hospitals and two nursing homes were asked to participate in the project. A total of 394 questionnaires were received for all modalities: 73 for in-person sessions, 50 for desktop conferencing, 227 for Web pages and 44 for CD-ROM. This represents a 100% response rate from the in-person, desktop conferencing and CD-ROM groups; the response rate for the Web group is unknown, since the questionnaires were completed online. Almost all participants found the modules to be helpful in their work. The CD-ROM group gave significantly higher ratings than the Web page group, although all four learning modalities received high ratings. A combination of all four modalities would be required to provide the best possible learning opportunity.

Education, Distance↗
PubMed2003

The Pentalfa project. 2: profile of participants and economic aspects.

A distance continuing medical education programme was established at the Katholieke Universiteit Leuven using multipoint videoconferencing via ISDN lines at 384 kbit/s. During each of the first three academic years of the project, two or three periods of eight or nine sessions each were organized (a total of 74 sessions). A questionnaire was given to all participants to determine the profile of the users and the efficiency of the project. Sixty-five per cent of the participants were male. The proportion of female participants was higher at the central location than at the peripheral sites. The mean age of the participants was 37.7 years (SEM 0.3). Male participants were older than female ones. At the central location, the mean age was lower than at the peripheral locations. Nearly 90% of the participants at the peripheral sites said that they saved time by attending a videoconference session. The average time saving per participant at the peripheral locations increased from 99 min in the first year to 145 min in the third year of the project. The time saving was closely related to the distance between the peripheral location and the central location. The global cost per participant at the peripheral locations was 43.7 Euros per hour of broadcasting and the indirect estimated cost-saving was 64 Euros per hour. More than 85% of the participants at the peripheral sites stated that they would no longer travel to Leuven (the central location) for these sessions if they were to be organized in a traditional, face-to-face manner, mostly because of the time required, particularly in road travel.

Adolescent↗
PubMed2003

Minor injuries telemedicine.

A minor injuries telemedicine network in Grampian connects 14 accident and emergency departments in community hospitals to a teaching hospital department. In a six-month study, 407 new telemedicine consultations met the inclusion criteria. Rates of transfer for treatment to the base hospital were used as an outcome measure. Fourteen out of a total of 19 members of medical staff gave telemedical advice. They were mainly middle-grade accident and emergency doctors. Transfer rates were 16-48% (median 29%) across staff. The rates did not seem to be affected by the base doctor's seniority, but were a reflection of that doctor's experience of and confidence in using videoconferencing equipment for clinical purposes. Transfer rates decreased as experience increased. Training for doctors undertaking the provision of specialist advice should include the clinical practicalities of making remote diagnoses.

Emergency Service, Hospital↗
PubMed2003

Telepsychiatry in the Canary Islands: user acceptance and satisfaction.

A telepsychiatry service, using ISDN videoconferencing, was established to provide psychiatric consultations for the population of El Hierro, the most westerly of the Canary Islands. During the first year of routine operation, a total of 40 patients had 40 initial and 126 follow-up teleconsultations. The main reason for the consultation identified in the general practitioner's referral form was to establish a diagnosis (60% of patients); the second most common reason was the management of a patient previously diagnosed (20% of patients). According to the results of a questionnaire survey, patients' acceptance of and satisfaction with the technology were high. In their first teleconsultation, about a third of them said that they experienced some initial inconvenience, but this disappeared after a few minutes. Ninety per cent of the patients considered that they received the follow-up care they required. Telepsychiatry was considered by physicians and patients as an adequate vehicle for mental health-care.

Adolescent↗
PubMed2003

The acceptability of telemedicine for podiatric intervention in a residential home for the elderly.

We investigated the use of telemedicine in the diagnosis and treatment of foot disorders. In an eight-month study, 49 residents of a local 200-bed home for the elderly, who had a potential or active foot problem, were examined via videoconferencing. They were subsequently examined on site. Their mean age was 86 years (range 67-100 years). There were 49 consultations for new cases and 50 follow-up consultations; therefore 99 teleconsultations and 99 on-site consultations were carried out. After 15% of the teleconsultations, an on-site visit was still required for full assessment of the case, as a diagnosis could not be determined. In 6% of teleconsultations there was difficulty in determining an accurate management plan. Telepodiatry was found to be satisfactory in the remaining 79% of cases and 87% of clients preferred teleconsultation to being transported to the hospital clinic. Telemedicine was found to be an acceptable method of providing some aspects of podiatry care to clients living in a residential home for the elderly. It was an excellent triage mechanism, and facilitated earlier identification of and intervention for urgent problems.

Aged↗
PubMed2003

Remote assessment of the use of seclusion and restraint with paediatric psychiatric patients.

Agencies regulating US psychiatric inpatient facilities require face-to-face patient assessments by physicians within one hour of the use of seclusion or restraint. In a pilot study, we compared face-to-face and remote assessments using videoconferencing in relation to response times and physicians' ratings of aspects of seclusion or restraint events involving paediatric patients at a private psychiatric hospital. Fifteen paired face-to-face and remote assessments were compared. Remote assessments occurred more rapidly than face-to-face assessments and more took place while seclusion or restraint was still being used. There was little disagreement between the physicians' ratings in face-to-face and remote assessment conditions. Remote assessment may therefore be a rapid and reliable method for physicians to evaluate the use of seclusion and restraint.

Adolescent↗
PubMed2003

User satisfaction with rehabilitation services delivered using Internet video.

Rehabilitation services to four remote sites in New Brunswick were delivered via PC-based videoconferencing equipment, using ADSL connections to the Internet. Approximately 40 people used the equipment over 18 months. There were 32 videoconference sessions. A total of 60 questionnaires were returned (a 94% response rate). In 31 of the 32 videoconferences, a connection was successfully established between the computers. The videoconferences lasted on average 20 min. The most frequent applications were viewing of rehabilitative equipment and video communication. The technology was found to be useful and provided an enhanced form of communication from the video component. There were some problems with the stability and reliability of the equipment.

Humans↗
PubMed2003

Feasibility and outcome evaluation of a telemedicine application in speech-language pathology.

This evaluative study assessed the feasibility and outcome of delivering speech-language services from a distance to children and adolescents who stutter. All six patients who formed the first cohort seen in the telespeech programme were included in the study. The results demonstrated that interactive videoconferencing can provide a feasible and effective care delivery model. Patient attendance was maintained throughout the intervention. All participants showed improved fluency. Stuttering ranged from 13% to 36% before treatment and 2% to 26% after treatment. All participants maintained at least part of their improved fluency during the six-month follow-up, when stuttering ranged from 4% to 32%. The study demonstrates that full assessment and treatment of stuttering in children and adolescents can be accomplished successfully via telemedicine.

Adolescent↗
PubMed2004

A simple telemedicine system to provide second-opinion advice to the patients of an Albanian diagnostic centre.

Since August 2003, the IKEDA Klinika diagnostic centre in Tirana, Albania, has offered patients telemedical help from Greece. The teleconsultation service is based on Internet technologies adapted to telemedical use, including the use of forms (e.g. for the patient history), multimedia file exchanges (e.g. for radiographs and electroencephalograms) and videoconferencing. The teleconsultants assist in treatment planning and, when necessary, in organizing the transfer of patients to Greece. The four cornerstones of the service are: the provision of second opinions by telemedicine; assistance in treatment planning; assistance to patients during transfer; and the continuity of medical care on their repatriation. Based on the first six months of operation, we estimate that, if bureaucratic visa restrictions to patient movement between Albania and Greece are removed, more than 2000 patients per year will benefit from the service and more than 400 patients will be transferred to Greek hospitals for treatment.

Albania↗
PubMed2004

Evaluation of an accident and emergency teleconsultation service for north-east Scotland.

We evaluated an accident and emergency teleconsultation service provided to 14 community hospitals in north-east Scotland. Each community hospital was equipped with a videoconferencing system and a document camera to allow transmission of radiographs. The network used 384 kbit/s ISDN connections. A total of 1392 teleconsultations were recorded during a 12-month study period. Seventy-seven per cent of patients (n = 1072) were managed locally and 23% (n = 320) were transferred to Aberdeen. The majority (95%) of teleconsultations were conducted on weekdays, and 90% of these occurred between the hours of 09:00 and 16:00. The mean delay in contacting a doctor was 9 min and the mean consultation time was 10 min. The majority of patients were suffering from fractures or suspected fractures of the limbs. Radiograph transmission was used in 75% of all teleconsultations. A high degree of satisfaction was recorded by all users of the service.

Adult↗
PubMed2004

Telemedicine for multidisciplinary lung cancer meetings.

According to recent UK guidelines on the management of lung cancer, all cases should be reviewed prospectively by a lung cancer multidisciplinary team (MDT) and a thoracic surgeon should be readily available to liaise with the MDT. However, there is a shortage of thoracic surgeons in the UK. Over a one-year period, 28 MDT meetings were held at a district general hospital in Southend, at which 62 patients were presented to a tertiary cardiothoracic centre in London, 80 km away, via ISDN videoconferencing at 384 kbit/s. The annual resection rate increased by 30% following the introduction of the telemedicine MDTmeetings, and the mean time from first being seen in the clinic to surgery was reduced from 69 to 54 days.We estimate that the telemedicine meetings saved over three working weeks of thoracic surgical time during the year.

England↗
PubMed2004

Nurse and patient communication via low- and high-bandwidth home telecare systems.

We examined nurse-patient communication on two videoconferencing systems: a video-phone (PSTN video) and a PC-based system (IP video). The former used data transmission via a modem at 33.6 kbit/s and the latter via a local-area network at up to 512 kbit/s. Twenty-six nurses and 18 volunteers (simulated patients) participated. On each video system nurse-patient dyads completed scripted interactions; they then completed questionnaires to assess communication. Of the participants, 84% (n=37) preferred IP video and 14% (n=6) preferred PSTN video (one expressed no preference). IP video was rated significantly higher in all communication quality areas except self-consciousness/embarrassment. Although participants' overall ratings were higher for the IP video system, two important advantages of the PSTN video system were identified by both nurses and patients: first, it provided superior visualization of the medication bottle, insulin syringe and the patient's skin; and second, it was easier to use. Video quality and audio quality are important determinants of patient and provider perceptions, but ease of use, clinical appropriateness, and the need for training and support must not be forgotten.

Adult↗
PubMed2004

Performance of a web-based, realtime, tele-ultrasound consultation system over high-speed commercial telecommunication lines.

A Web-based, realtime, tele-ultrasound consultation system was designed. The system employed ActiveX control, MPEG-4 coding of full-resolution ultrasound video (640 x 480 pixels at 30 frames/s) and H.320 videoconferencing. It could be used via a Web browser. The system was evaluated over three types of commercial line: a cable connection, ADSL and VDSL. Three radiologists assessed the quality of compressed and uncompressed ultrasound video-sequences from 16 cases (10 abnormal livers, four abnormal kidneys and two abnormal gallbladders). The radiologists' scores showed that, at a given frame rate, increasing the bit rate was associated with increasing quality; however, at a certain threshold bit rate the quality did not increase significantly. The peak signal to noise ratio (PSNR) was also measured between the compressed and uncompressed images. In most cases, the PSNR increased as the bit rate increased, and increased as the number of dropped frames increased. There was a threshold bit rate, at a given frame rate, at which the PSNR did not improve significantly. Taking into account both sets of threshold values, a bit rate of more than 0.6 Mbit/s, at 30 frames/s, is suggested as the threshold for the maintenance of diagnostic image quality.

Data Compression↗
PubMed2004

The feasibility of telemedicine for the training and supervision of general practitioners performing ultrasound examinations of patients with urinary tract symptoms.

Ultrasound examinations were carried out by a general practitioner on patients who presented with lower urinary tract symptoms. To assist in the interpretation of ultrasound anatomy, still images were captured during the ultrasound examination and transmitted to a university expert. In total 15 telemedicine sessions were conducted, using PC-based videoconferencing equipment connected by ISDN at 128 kbit/s. Fifteen patients were randomly selected and both the transmitted and hard-copy images (printed on thermal paper) were graded for technical quality. Data were missing for 13 of the possible 105 paired comparisons, as some images could not be evaluated. Overall agreement between the technical quality scores for the transmitted and hard-copy images was poor (weighted kappa=0.04). The 105 transmitted images were also rated for their diagnostic quality: 90% were classified as diagnostic and 10% were judged to be non-diagnostic. The results show the feasibility of tele-ultrasound in primary care. The general practitioner concerned benefited from regular ultrasound training and supervision, and achieved a satisfactory level of clinical competency in scanning the prostate, bladder and kidneys.

Clinical Competence↗